A longtime proponent of reducing tests and improving patient care, Gary W. Procop, MD, MS, FASCP, is an expert panelist for the ASCP 2013 Chicago general session on the Choosing Wisely campaign. He shares his perspectives on how laboratories can lead their organizations in promoting appropriate test utilization. As Chair of Molecular Pathology at the Cleveland Clinic, Dr. Procop led the Clinic’s highly successful review process of duplicative testing, which has become a model for the health systems across the country. Links to the complete transcript of the interview, as well as the Cleveland Clinic’s Test Utilization Committee Final Report, are below.

Question: What are some ways in which pathologists and lab professionals can encourage laboratories to promote the Choosing Wisely campaign in their hospitals, practices, or labs?

Answer: The first step is awareness. Pathologists and laboratory professionals need to engage the medical leadership in their institutions. Hospital administrators, the chief medical and surgical operations officers, and department chairs are usually interested in evaluating best practices, particularly when they also involve cost-savings measures. These individuals are important allies for the systemwide implementation of test utilization initiatives.

“Many lessons have been learned on our journey in improving test utilization. Usually, when one considers 'Lessons Learned,' they usually mean, 'What did we do wrong?' It is just as important to share what we did right.”
— Gary W. Procop, MD, MS, FASCP

Q:What are a few of the key messages you will share at ASCP 2013 Chicago on the topic of appropriate test utilization?

A: The first message is that implementing best practices for test utilization is a team effort. It is important to not dictate to clinicians, even if you are correct. It is important to employ competency skills in the realm of communication and professionalism to work within a team structure toward implementing best practices for patient care. In many instances, the path toward best practice implementation includes some kind of compromise.

A: The team should include laboratory professionals, one of which I would recommend to chair the committee. I recommend having an open committee with broad representation from many clinical services. It is important that the committee has support from hospital management and medical leadership. The impending actions of the test utilization committee should be communicated with the medical staff, and, whenever possible, feedback should be sought.

Q: As part of this initiative, what does the Cleveland Clinic’s test-ordering process looklike?

A: The Cleveland Clinic invested early in a complete electronic health medical record for the Cleveland Clinic Health System (CCHS). This system includes computerized physician order entry (CPOE), so the physicians enter the test orders directly into the system. This type of an entry system allows physicians to create order sets for common disorders encountered in their practice. It also allows for medical laboratory professionals to review ordering patterns throughout the healthcare system.

Q: Do you think laboratories fully realize the critical role they have in our changing healthcare environment? If not, how can laboratories improve?

A:I do not believe laboratories fully realize their critical role in the changing healthcare environment. Laboratory professionals often are the most knowledgeable individuals in the institution concerning tests in their areas of expertise and oversight. The challenge is for our groups to get out from behind the microscope and out of the sub-basement, and exercise their communication and interpersonal skills muscles, and to interact with hospital leaders.

For a complete transcript of this interview, click here. To learn more about the work of the Cleveland Clinic’s Test Utilization Committee, click here.